Paula's Perspicacity

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Then, somehow, from a place beyond sense or strategy, she breaks forward, unpinned from her body’s flaws and marvels. It’s only courage that takes her the final distance. Only grit. ~Paula McLain

As I was struggling through a 4-mile run last week, I was listening to Circling the Sun by Paula McLain. Horse racing is one of the main topics of the book, and the protagonist, a rare female trainer in the 1920s, needed her horse to win. The horse had started out strong, but was not in the lead as the end of the race approached. The passage above describes how the horse found her reserves and transcended what she was physically capable of in order to win. She became unpinned from her body’s flaws and marvels, buoyed by courage and grit.

My body’s flaws are winning over courage and grit, and I am trying to figure out how to get them all to make peace with each other.

After having my procedure on April 6, 2015, I went on my first mile run on April 14. It took 14:06 to run 1.06 miles (13:17 pace). My average heart rate was 143 and my max heart rate was 153. On June 4, 2016, about 14 months later, it took 57:42 to run 3.16 miles (18:16 pace). My average heart rate was 138 and my max heart rate was 197. Both times (all times between now and then), I had taken my beta blocker a half hour before starting the run.

Although there have been a few brief visits to the sub-13:00 per mile speed over the past 14 months, it has been far more typical for my average pace to be in the 14’s, 15’s, or 16’s. For me, running on beta blockers is like running through mud.

I suppose my hope after the electrophysiology study, once I knew there had been no ablation and the ongoing plan involved medication before every run, that I could reach some consistent “status quo.” It has taken me the whole 14 months to begin to let go of my years-old goal of running a sub-30 5K, but as time passes the question becomes “where does running fit for me at all?”.

Is running still good for me physically?

Although I am fortunate to have an electrophysiologist with a great way of explaining things and a respect for the sport of running, he also says, “you know it’s not necessary to get your HR up to 160 (or whatever…) for it to be a workout,” right?

He’s right – I can get a good workout in a multitude of ways that don’t escalate my heart rate like running does.

But they are not running!

Nothing I have read online, no doctor I have spoken to, no one I know who has tried to combine running with an arrhythmia situation really has the clear answer.

Probably the best summary is: running while experiencing tachycardia is not generally as dangerous as it sometimes feels. BUT given that my EP thinks mine is likely to convert into atrial fibrillation (which increases stroke risk) over time, and the fact that I usually run alone, and the fact that I have to err on the conservative side because I want to be around to see my kids grow up, I think I have to assume that running to the point of abnormally high heart rate is not necessarily the healthiest choice for me. (Ironically, if it DOES turn into AF, I will be a candidate for an ablation again, and it is likely to work, but I can’t engineer that situation into being.)

What do people think?

If I had a dime for every time I have said, in all sincerity, to another runner or prospective runner, “you’re only competing against yourself,” “every mile matters,” or “you’re lapping the person on the couch,” I would be wealthy.

However, I would be totally lying if I didn’t say these are the thoughts that have dogged me over the past few months. At first, after the EP study, I thought I would reach that comfortable status quo, and just blend into the scenery at races, just log my usual refreshing and energizing training miles, just keep doing something good for my body (and mind) out on the roads and trails.

But that little “how can you still call yourself a runner?” voice in the back of my head will not stop its incessant pestering.

When I post my times to DailyMile and people see it took me 18 minutes to run a mile.

When I stop right before the finish line as I did at Gate to Gate and walk little circles off to the side while doing a Vagal maneuver to try to get my HR down from 197 so I am not running the risk of passing out in public as finish line adrenaline kicks in.

As I tell people “really, no, don’t wait for me. I’m going to take FOREVER.”

As I participate in races, trying to keep my feet running without my heart noticing they are while my head tries to mediate between the two

As I stopped logging my food and gained back 25 pounds I lost while training for a half marathon (and obviously my cookies-every-day habit has nothing to do with my tachycardia except for the fact that I know my mindset and my eating choices are inextricably intertwined right now).

You Can’t Trust Technology Blindly Without Listening to Your Body Too

Even when you have the best technology, you still have to pay attention to your body. Back in November-December of 2015, I was seeing “high” readings on my Garmin. These readings, for example, led me to run/walk the Turkey Trot rather than solely running it at a moderate pace. I decided maybe the batch of metoprolol I had recently been given was “bad.” I called the Publix pharmacy which had dispensed it, which said it was fine. I called my EP’s office, which confirmed the readings from my loop recorder were fine. It turns out my receiver on my Garmin chest strap was bad (oops!). I ordered a new one and the problem was solved. Now I follow the care instructions for my chest strap to the letter (it has to be cleaned often to prevent salt buildup).

How do I still contribute to the running community?

Running pervades every single aspect of my life. If I’m not dressed up, I’m almost always in a race shirt. If I am packing for a trip, the running shoes go in first. If it’s a weekend, my review of possible activities always involves which races are being run. I am a running groupie, and running people are my favorite people.

I have commitments as a Fitfluential Ambassador, a Charity Miles All-Star, and as a runner for Gareth through I Run for Michael. I know Gareth’s family “gets it” because he also has an invisible condition (a mitochondrial disorder). I know Charity Miles has my back – I can walk/bike and/or keep running 18 minute miles and #everymilematters still applies because the causes we love benefit. Fitfluential is a bit more challenging. I can only hope that my choices during this frustrating interim period help someone else who is struggling know they are not at all alone and you can have a love of fitness without looking like a fitness magazine model.

While I suppose it would be an easier thing to discuss if I had a cast on my leg or some other outward physical sign of a health challenge, an invisible condition like a cardiac arrhythmia with questionable impact plays a different role in the multi-act play that is my running life.

I suppose I am at the intermission and the second act of this play has not been written nor rehearsed yet.

In the 24 hours leading up to my EP Study on Monday, I asked myself quite a few times if it made sense to go through with the procedure, especially since my high heart rate episodes only occurred when I was running. In other words, even though the risks are minimal, is it worth having a doctor thread a catheter up through my groin into my heart in order to figure out what was going on in there and to possibly “ablate” any problem areas?

To get to the point of today’s blog, we will fast forward past the referral process to get to the electrophysiologist, the initial appointment with the electrophysiologist, the implantation of my loop recorder, appointment number one with the electrophysiologist’s nurse, a between-appointments phone call with the nurse where I was instructed to begin taking two baby aspirin every night (I was already taking one) and appointment number two with the electrophysiologist’s Physician Assistant (PA), where I was given the choice of medication or an EP Study with Ablation. Because I was hesitant to settle for a medication-only option (I was concerned medication would make me more tired than I already am all the time and would not yield any answers), I agreed to proceed with the EP Study and Ablation on the premise that a) at least I would have answers and b) if I did get an ablation, I would be able to return to running with a likelihood of less risk, more satisfaction, and a relieved mind.

I reported to the hospital at 7 a.m. on Monday, and did a combination of laying around, prepping (there is some cleaning with grown up baby wipes to be done), having a baseline EKG taken, having baseline vitals taken, chatting with the anesthesiologist, a visit from the PA, and a final visit from the electrophysiologist before the process began.

From an anesthesiology perspective, the goal with an EP study (at least with this team) was not to keep the patient completely “out.” I did have them promise not to share any crazy tequila stories I told while I was in and out (apparently either I didn’t give them anything to work with or they are very discreet people!). I was given oxygen. I remember nothing of the actual insertion of the catheter. I remember significant parts of them manipulating my HR to try to replicate the issues I have been having. One of the cool parts of an EP study is that they essentially “GPS” your heart. I had stickers all over my chest that were a part of the mapping process (and is it a good thing when they say they don’t have much real estate to work with?!). The anesthesiologist told me that he could tell at a certain point that I was really getting anxious (and I was trying to stay calm but I guess “trying” is a relative thing in that situation) so he put me farther out.

Fast forward to the recovery room. and beyond. I remembered how still Wayne (my husband) had to be after his catheterization, and how we had to bring Wayne’s dad back to the hospital when he began bleeding from his insertion site after a catheterization so I was determined to be the perfect patient on that front. But I think the process and technology have both improved. Although you are told to remain very still, there wasn’t a nurse yelling at me when I moved my head a millimeter (as one did with Wayne).

Dr. Silberman chose not to ablate – he found two “hot spots” that activate at around 160 bpm, but they return to normal as my HR rate escalates and several other spots activate. It was taking so much medication (isuprel) to get my HR up enough to replicate the issue that they were afraid they would run out mid-procedure and apparently there is a manufacturers’ shortage of it so they couldn’t get more. One option is a different (more involved) procedure with a balloon that can discover/ablate more surfaces at once, but that is not necessarily the obvious route to go. For now, the recommendation is that I take a beta blocker before running and keep my HR to below my zone 4.

Here are the takeaways for now:

Technology is pretty awesome

I am still in awe at what medical professionals can find out via technology. From my Garmin which provided preliminary data about the patterns of my heart rate issues, to the loop recorder that provided more specific information, to the map of my heart and its electrical patterns, we have access to so much data.

Physicians with good bedside manner are pretty awesome

I am grateful for the way in which Dr. Silberman has explained everything at each step of the way. I appreciate the fact that he respects the role of running in my sanity (even though he does say, repeatedly, “you know, you don’t have to exercise at 170 bpm to be fit”).

Good nurses are pretty awesome

I am a little fuzzy on my ability to evaluate the performance of some of the nurses, but all the ones I was “with it” for were great. They were patient, answered my questions, and provided plenty of attention (along with a nifty “discharge note” (below) and a follow-up phone call the evening I was discharged. My last nurse had an interesting mantra — “be assertive” — she said it ten times if she said it once. She’s right of course but it still struck me as interesting.

Remember that post I wrote about how hard it is to get a wheelchair at TMH?

I have to admit, when I remembered (duh) that I would need one of those very same wheelchairs to transport me out of my room and down to my car, I was a little afraid the staff would see my name and all of a sudden develop a very lengthy d e l a y! But my complaint was never about the transportation staff themselves, just the challenging process of getting a wheelchair for my father-in-law, and I am happy to report my chariot arrived to sweep me away from the hospital relatively promptly.

Frequent naps and permission to “take it easy” are awesome

I was told to avoid running/exercise (sigh) and not lift anything heavier than ten pounds for a week. As much as I have missed my usual high-intensity, rapid-fire life, I have to admit having permission to take it easy has its bonuses too. I have probably taken more naps in the past week than I have in the past year (or five…). I think I needed the rest.

Not running is not awesome

Double negative that may be … but if you know me, or if you have had your own period of enforced non-running, you know what I mean. All of a sudden everyone’s off-hand remarks on social media about their “quick three-milers,” “couldn’t help signing up for another race,” and “awful run but I am glad I did it” seem like they are coming from a completely different universe. My paper workout chart, my Training Peaks, and my Daily Mile are all completely blank this week. So is my endorphin quota. It’s odd and not awesome.

So much of your running mojo is in your head

This has messed with my mental status. As much as I have advocated endlessly for the power of the back of the pack, for the fact that every mile matters, for the fact that runners should all support one another, the truth is that I have felt very close to the edge of being excommunicated from the runner fraternity (and I know if anyone else said all that to me I would immediately jump on them and tell them the thousand reasons why they still belong). I’m just keeping it real here. I have finally gotten a little tiny bit of traction and credibility as a Fitfluential Ambassador and am having to work hard to convince myself I still belong.

Not running messes with your nutrition

One beautiful thing about running combined with relatively clean eating habits was that I had a little wiggle room to treat myself to “fun food” occasionally. A few weeks prior to the procedure I announced to my coach that I was “tired of logging.” Although I knew what to do to maintain my weight, I also know how easy it is to wander once you are no longer making yourself accountable. Logging and reporting my food logs to my coach every night incentivized me to, for example, have salads on hand for lunches, to skip bread in the evenings, and to keep the long-term goal in mind.

And I think that’s the rub now: there is no long term goal now that I have ditched the sub-30 5K. The things I run for still exist: Gareth, Charity Miles, my team at KR Endurance, my running friends, my health and my sanity.

The challenge is getting my head (and my heart) back in it.

****NOTE: I really hate talking endlessly about myself like I have ended up doing throughout this cardiac health journey. I continue because I know it has helped me to read of other people’s experiences. It’s a scary and lonely feeling to feel like “the only one” facing this type of issue. A lot of people have helped me, especially Mary Jean Yon. While I don’t feel ready to be anyone’s lifeline yet, it is important to know you are not alone, and to be your own most assertive advocate when it comes to your health. That’s why I keep talking about it. Maybe next week I’ll post about dancing unicorn kittens or something lighter!

I Got To Travel

I love traveling so much. Getting to take a quick road-trip to Panama City Beach in order to participate in this race fed a bite-sized morsel to the voracious travel lover in me. Packet pick-up was at the Edgewater Beach and Golf Resort, home of several memorable gymnastics experiences back in my Gym Mom days. Wow did that make me nostalgic.

I Got To Run

Running is so central to who I am. A trip that does not involve running is very likely not a trip I am on! It was so nice to enjoy the sound of the ocean waves as we traversed Front Beach Road throughout the half marathon course, to share my friend Tabitha’s first ever half marathon (yay!), and to experience just a little bit of relief from the stress that has hung over my races and runs since the Turkey Trot. (Note for anyone following the health part of the Turkey Trot post, I have an appointment with an electrophysiologist on January 6 and will hopefully get closer to having some answers.)

I Got To Cuddle With A Dog

Okay, cuddling with a dog doesn’t represent a component of my year, but spending a half marathon with Minnie Pinnie was a SURPRISE! Oh how I love this 5-month-old, 4 pound bundle of awesomeness who did the entire 13.1 miles (carried for much of it) in a tutu that matched her mom’s. She made every single person who passed her smile (even the ones who mistook her for a chihuahua). She spent the ride back to Tallahassee curled up in my lap, fast asleep (admittedly, I did a little snoozing too). Takeaway for the year? Be open to new surprises. This “not a dog person” was won over in short order.

I Got To Support My Friends and Be Supported By Them

Ostensibly I was doing this race to support Tabitha as she ran her first half, but making the arrangements reminded me that it is okay to ask for help sometimes. Neither of our cars is really up to a long trip, and I was hoping to make it cost effective by sharing a hotel room, so I asked for help. All of that worked out, and moments along the way, such as this exchange with my dear friend Arlene, said “support” without saying a word:

I Got To Be Myself

As I wrote about in this post and this post, some of my struggles this year have been related to insecurity and lack of feeling accepted, with a dash of the feeling that I am more “myself,” and less inhibited on social media than I am with the people I spend time with in real life. The camaraderie, jokes, and shared moments of this weekend built rather than eroded; that was a plus.

Race eve dinner!

I Got To Write About It

This should be self-explanatory. The finish line of the last race of 2014 behind me, now I write. Although it’s true I will write about anything, but deeper truth is that I am inclined to write regarding just about everything. Look for that to continue in 2015.

Lastly, I Am Looking Ahead to Making The Finish Line Count

In thinking back through this weekend’s half marathon, I have noted how it captured many of the parts of 2014 I loved, including travel, running, friends, and writing. One of my main projects for 2015 will be participating in the 2015 New York City Half Marathon as part of Team SOAR which is running for the Leukemia and Lymphoma Society. What do you know? I get to travel to it, get to run at it, will be with friends old and new, and will inevitably write about it! It’ll have everything except the miniature pinscher! (I do have a commitment to fulfill in support of the Leukemia and Lymphoma Society in order to participate, though. Here’s my link if you feel inclined to donate — no amount is too small!). I just received my training shirt today, and it seems perfect as I start 2015: